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Response to Recent Media Attention on Billing Practices at the University of California, Davis Veterinary Medical Teaching Hospital

August 19, 2016

Recently, a Bay Area media outlet brought attention to animal owner complaints about billing practices and veterinary licensure requirements for veterinarians at the University of California, Davis Veterinary Medical Teaching Hospital (VMTH). 

The School of Veterinary Medicine is disappointed that despite our efforts to respond to questions from reporters with this outlet, they chose to ignore much of the content provided and instead focused primarily on the complaints themselves, some of which contained erroneous information.

Because we are bound by client confidentiality agreements, we cannot discuss specific patient cases. The purpose of this communication is instead to explain how patient treatment plans are developed and client billing is handled at the VMTH, including in the hospital’s Small Animal Clinic.

The clinicians and staff at the VMTH are a team of hard-working and highly-educated individuals, exceptionally dedicated to providing the best veterinary care in the world for all creatures great and small. Currently, the VMTH provides more than 50,000 patient visits annually and has been fully accredited by the American Animal Hospital Association since 1979, with extremely high scores following the last accreditation review in 2014. That review included scores of 5470/5480 for patient care, 3750/3750 for surgery, and 930/930 for emergency and critical care. 

The hospital responds to less than 20 written complaints a year, which represent less than 0.05 percent of all patient visits. These included the three complaints addressed by this media outlet. The hospital continues to have a proven track record of successfully caring for our animal patients and communicating with and supporting our clients, as evidenced by the abundance of positive written communications that we receive each year. 

Like private veterinary clinics, our hospital must bill to cover its costs; however, the ultimate goal is always to provide the best care and treatment so that each animal can return home with a high quality of life. When clients bring their companion animals to the hospital for care, our veterinarians recommend a plan of treatment, after having discussed with the client the animal’s health status and various treatment options, including estimates of the cost that would be involved.

Animal patients are afflicted with a wide array of ailments, and potential treatments can be very specialized and costly, sometimes rising beyond what the client is able to or chooses to spend. This is particularly true at our hospital because we are a tertiary referral hospital with special expertise and advanced facilities, often receiving referrals from other veterinary clinics and specialty hospitals throughout California.

The cost of veterinary care is rising with improvements in medical care and technology, and animal owners often desire the same level of care for their animals that they would for human family members. Many of the procedures used in human medicine are commonly applied to the care of animals, including ultrasound examinations, endoscopy, laparoscopic surgery, imaging using computed tomography (CT), magnetic resonance imaging (MRI) and now positron emission tomography (PET).

Unless pet owners have pet health insurance, the cost of performing these procedures must be paid for by the pet owner. In human medicine, these costs are not always appreciated by the patient because of health insurance coverage. Indeed, veterinarians charge significantly less for the same work provided by human medicine doctors, but the costs of complex care similar to that used in human medicine can exceed several thousand dollars.

After a patient is examined and a treatment plan and options are discussed and agreed upon with the owner, pet owners must provide a deposit, which varies according to the type of diagnostics and treatment needed. Our current hospital policy is that a deposit is required for patient care when the estimated cost of diagnosis and treatment exceeds $1,000. If the low end of the estimate is up to $2,999.99, we request a deposit that is 50 percent of the high end of the estimate. When the low end of the estimate is $3,000 or greater, we request 100 percent of the low end of the estimate. With the exception of emergency situations, our veterinarians will only proceed with treatment after the client has provided signed consent and the deposit. 

At any point in the treatment plan, the client has the option to halt treatment, or discuss a different treatment plan and avoid incurring further expenses. At times, the decision to halt treatment may mean that no further improvements can be made in the health and well-being of the animal, or that the animal’s health deteriorates. 

In such a case, we discuss possible outcomes with the owner depending on the circumstances, including taking the animal home to live out the remainder of its life with basic supportive care, transferring to a local veterinary clinic for a lower level of care, or humane euthanasia. The choice to euthanize is never easy and always requires owner permission after careful consideration of our doctors’ input and recommendations.

Unanticipated outcomes and medical errors occur in veterinary medicine just as they do in human medicine, but we work exceptionally hard to inform our clients of risks and minimize adverse outcomes. Between July 2015 and August 2016, we anesthetized 4,475 dogs and cats, many with serious underlying conditions, with an overall mortality rate of 0.002 percent. The most recent report published in the literature for anesthetic mortality in veterinary practice was 0.17 percent in dogs and 0.24 percent in cats (Brodbelt et al, 2008). Our hospital’s client services managers work with our doctors and staff to resolve any complaints that we receive from clients regarding patient care or billing. In the case of written complaints about patient care or requests for reimbursement, the hospital’s client services manager works together with the chief of the relevant hospital specialty service or the clinic director, if multiple services were involved in the animal’s care, to investigate the case and related billing. We also have a faculty-led Committee on Clinical Outcomes that monitors and investigates adverse events within the hospital. 

Clients must sign an informed consent form if their animal is participating in a clinical trial or novel procedure with an unclear outcome. All clinical trials are carefully reviewed and approved by our Clinical Trials Review Board and Institutional Animal Care and Use Committee before they are allowed to commence, so no ‘research’ is done using client-owned animals without consent.

As noted by the Bay Area outlet, all veterinarians employed by the University of California, Davis, School of Veterinary Medicine and by the Western University of Health Sciences College of Veterinary Medicine (the only private veterinary school in California) are exempt from holding a license under the California Veterinary Medicine Practice Act. This exemption also applies to veterinarians employed by the State or Federal Government and working in California. California is not different from other states with academic veterinary teaching hospitals, most of which exempt faculty veterinarians from holding a state license or require a university license. 

This fact that our veterinarians are not required to hold state licenses does not mean they are under qualified – quite the opposite is true. Our veterinarians are among the most highly trained and highly qualified in the world.

The Veterinary Medical Teaching Hospital offers the most comprehensive specialty patient care of any academic teaching hospital in the U.S., with more than 30 disciplines. Most of our faculty veterinarians have advanced clinical training and are specialty board certified in disciplines approved by the American Veterinary Medical Association’s American Board of Veterinary Specialties.

Many faculty veterinarians also have a current California license. As noted by the Bay Area report, the University of California, along with Western University, has been working proactively with the California Veterinary Medical Board over the past two years to develop a university license, which will become law in January 2017. This will allow us to continue to recruit the best veterinarians worldwide in order to maintain the quality of our clinical programs.